Innovation Mental Health Services Corp

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

2465 Issued in PR

Legal business name

INNOVATION MENTAL HEALTH SERVICES CORP

Practice address

5 Calle
Reparto Montellano
Cayey, PR 00736-4201

Phone

(787) 664-1101

NPI assigned

May 26, 2015

Last updated

Apr 15, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Victor M Gonzalez, PSYD

Title

Clinical Psychologist

Phone

(787) 664-1101

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460678400000",
    "number": "1306225248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 CALLE",
            "address_2": "REPARTO MONTELLANO",
            "city": "CAYEY",
            "state": "PR",
            "postal_code": "00736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CALLE",
            "address_2": "REPARTO MONTELLANO",
            "city": "CAYEY",
            "state": "PR",
            "postal_code": "007364201",
            "telephone_number": "787-664-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATION MENTAL HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-26",
        "last_updated": "2016-04-15",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "787-664-1101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "PR",
            "license": "2465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103TH0100X",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellimed, PSC
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• Health Service Psychologist in Cayey, PR
• Providers in Cayey, PR by specialty
• Health Service Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.